Impact of low voltage areas in sinus rhythm for the ablation of persistent atrial fibrillation

Abstract

Background Current ablation strategies for persistent AF have shown a limited success rate with frequent arrhythmia recurrences. Recent studies suggest that the atrial arrhythmogenic sites are related to regions with increased fibrosis detected by reduced bipolar voltage area. Purpose Targeting low voltage areas in addition to PVI may represent an efficient strategy for the ablation of persistent AF. Methods We prospectively included patients with symptomatic persistent AF (mean age: 63\xa0±\xa08.8 years, men 69.3%) ( Table 1 ). The ablation strategy consisted in circumferential PVI. Sinus rhythm was restored by electrical cardioversion. A voltage map was performed in sinus rhythm. Complementary ablation was guided by low voltage areas\xa0 Results In total, 101 patients with persistent AF were included. Low voltage areas ( Fig. 1 ): 32 on anterior wall (30.2%), 25 on septum (23.6%), 8 on posterior (7.5%), 3 on lateral (2.8%), 12 in left appendage (11.3%), 23 on the roofs (21.7%), 3 on inferior (2.8%). RF ablation was performed in all low voltage areas. At the end of procedure, 76 patients (75.2%) were non-inducible. At the end of FU of 18 months, and after a single procedure, 72.3% of patients were free of symptomatic AF (n\xa0=\xa073 patients) and 65.3% of patients (n\xa0=\xa066) were free of AF/AT recurrence. Atrial tachycardia occurred in 9 patients and re-ablated with success ( Table 1 , Fig. 1 ). Conclusion These results suggest that PVI with complementary RF ablation guided on low voltage areas may be an efficient strategy for ablation of persistent AF with low incidence of atrial tachycardia during FU.